Nursing Elites

1. The nurse is caring for a client who has a chest tube in place following a pneumothorax. The nurse notes that there is continuous bubbling in the water seal chamber of the chest tube drainage system. What action should the nurse take?

• A. Check for kinks in the tubing
• B. Notify the healthcare provider
• C. Replace the chest tube drainage system
• D. Reinforce the chest tube dressing

Correct answer: B

Rationale: The correct action for the nurse to take when observing continuous bubbling in the water seal chamber of the chest tube drainage system is to notify the healthcare provider. Continuous bubbling indicates a possible air leak, and the healthcare provider needs to be informed to assess the situation and take appropriate actions. Checking for kinks in the tubing (Choice A) may be done initially but is not the priority when continuous bubbling is present. Replacing the chest tube drainage system (Choice C) and reinforcing the chest tube dressing (Choice D) are not immediate actions needed in response to continuous bubbling in the water seal chamber.

2. The nurse is making assignments for a new graduate from a practical nursing program who is orienting to the unit. Because the unit is particularly busy this day, there will be little time to provide supervision of this new employee. Which client is the best for the nurse to assign to this newly graduated practical nurse?

• A. Whose discharge has been delayed because of a postoperative infection
• B. With poorly controlled type 2 diabetes who is on a sliding scale for insulin administration
• C. Newly admitted with a head injury who requires frequent assessments
• D. Receiving IV heparin that is regulated based on protocol

Correct answer: A

Rationale: The correct answer is A because a client with a stable infection requires less supervision and is suitable for the new nurse. Choice B involves insulin administration for a client with poorly controlled diabetes, which may require more experience and supervision. Choice C involves a newly admitted patient with a head injury who requires frequent assessments, indicating a need for close monitoring. Choice D involves a patient receiving IV heparin, which requires precise monitoring and adjustment based on protocol, making it a higher-risk assignment for a new nurse without close supervision.

3. The nurse is administering total parenteral nutrition (TPN) via a central line at 75 ml/hour to a client who had a bowel resection 4 days ago. Which laboratory finding requires the most immediate intervention by the nurse?

• A. Blood glucose of 140 mg/dL
• B. White blood cell count of 8000/mm³
• C. Serum potassium of 3.8 mEq/L
• D. Serum calcium of 7.8 mg/dL

Correct answer: D

Rationale: The correct answer is D. A serum calcium level of 7.8 mg/dL requires immediate intervention due to the risk of hypocalcemia. Hypocalcemia can lead to serious complications such as tetany, seizures, and cardiac arrhythmias. The other laboratory findings are within normal limits or slightly elevated, which do not pose an immediate threat to the client's health in this scenario.

4. A client receiving amlodipine (Norvasc), a calcium channel blocker, develops 1+ pitting edema around the ankles. It is most important for the nurse to obtain what additional client data?

• A. Bladder distention
• B. Serum albumin level
• C. Abdominal girth
• D. Breath sounds

Correct answer: D

Rationale: The correct answer is 'D. Breath sounds.' When a client receiving amlodipine develops edema, it is crucial to assess for potential heart failure, a side effect of the medication. Checking breath sounds helps in identifying any signs of pulmonary edema, a severe complication of heart failure. Choices A, B, and C are less relevant in this context. Bladder distention could be associated with urinary issues, serum albumin level with malnutrition or liver disease, and abdominal girth with gastrointestinal problems, none of which directly relate to the potential heart failure induced by amlodipine.

5. The healthcare provider is caring for a client with jaundice. Which serum laboratory value is likely to be elevated for this client?

• A. Amylase
• B. Creatinine
• C. Blood urea nitrogen
• D. Bilirubin

Correct answer: D

Rationale: Bilirubin is a key serum laboratory value that is likely to be elevated in clients with jaundice. Jaundice is characterized by a yellowish discoloration of the skin and eyes due to an excess of bilirubin, a breakdown product of hemoglobin. Elevated amylase levels are associated with pancreatic conditions, not specifically jaundice. Creatinine and blood urea nitrogen are markers of kidney function and are not directly related to jaundice.

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